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Riffelmann M.,Institute For Hygiene Und Labormedizin | Thiel K.,Zentrum fur Kinder und Jugendmedizin | Schmetz J.,Institute For Hygiene Und Labormedizin | Wirsing Von Koenig C.H.,Institute For Hygiene Und Labormedizin
Journal of Clinical Microbiology | Year: 2010

Measuring antibodies to Bordetella pertussis antigens is mostly done by enzyme-linked immunosorbent assays (ELISAs). We compared the performance of ELISA kits that were commercially available in Germany. Eleven measured IgG antibodies, and nine measured IgA antibodies. An in-house ELISA with purified antigens served as a reference method. Samples included two WHO reference preparations, the former Food and Drug Administration (FDA)/Center for Biologics Evaluation and Research (CBER) reference preparations, serum samples from patients with clinically suspected pertussis, and serum samples from patients having received a combined tetanus, diphtheria, and pertussis (Tdap) vaccination. Kits using pertussis toxin (PT) as an antigen showed linearity compared to the WHO Reference preparation (r2 between 0.82 and 0.99), and these kits could quantify antibodies according to the reference preparation. ELISA kits using mixed antigens showed no linear correlation to the reference preparations. Patient results were compared to results of in-house ELISAs using a dual cutoff of either ≥100 IU/ml anti-PT IgG or ≥40 IU/ml anti-PT IgG together with ≥12 IU/ml anti-PT IgA. The sensitivities of kits measuring IgG antibodies ranged between 0.84 and 1.00. The specificities of kits using PT as an antigen were between 0.81 and 0.93. The specificities of kits using mixed antigens were between 0.51 and 0.59 and were thus not acceptable. The sensitivities of kits measuring IgA antibodies ranged between 0.53 and 0.73, and the specificities were between 0.67 and 0.94, indicating that IgA antibodies may be of limited diagnostic value. Our data suggest that ELISAs should use purified PT as an antigen and be standardized to the 1st International Reference preparation. Copyright © 2010, American Society for Microbiology. All Rights Reserved.

Hoger P.H.,Zentrum fur Kinder und Jugendmedizin
Monatsschrift fur Kinderheilkunde | Year: 2015

Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in children. In 60–80 % of all cases it manifests during the first year of life. AD pathogenesis is characterized by an interplay between genetic disposition (barrier defect, excessive cutaneous inflammation) and an increased susceptibility to reacting to triggering factors (infections, allergens, “stress”). Therapy: In every stage of the disease, barrier therapy is crucial. Restoration of the defective barrier prevents transepidermal water loss as well as intrusion of allergens and pathogens from outside that promote cutaneous inflammation. Topical barrier therapy should be adapted to the disease stage, the location of the eczema, the season, and the age of the child. Proactive topical anti-inflammatory therapy is based on “modern” topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Among a wide selection of TCS, prednicarbate and methylprednisolone are preferred owing to their favorable safety/efficacy profile. According to recently published studies, the same applies to TCI, which are ideally suited for long-term therapy in order to prevent relapses. Conclusion: A total of 90–95% of cases can be effectively controlled by topical therapy tailored to the disease state and patient age. Therapy aims at disease control and prevention of recurrences. © 2015, Springer-Verlag Berlin Heidelberg.

Muller H.L.,Zentrum fur Kinder und Jugendmedizin
Nature Reviews Endocrinology | Year: 2010

Craniopharyngiomas have an overall incidence of 0.5-2.0 new cases per million of the population per year, and ∼30-50% of all cases represent childhood craniopharyngioma. These partly cystic embryogenic malformations of the sellar region are presumably derived from Rathke cleft epithelium. Many of the typical manifestations at primary diagnosis are nonspecific and include headache, visual impairment, polyuria and/or polydypsia, growth retardation and weight gain. Total resection is the treatment of choice in patients with favorable tumor localization, with the intention to maintain hypothalamic-pituitary and optical nerve functions. When the tumor localization is unfavorable, a limited resection followed by local irradiation is recommended. The overall survival rates are high (91-98%). High recurrence rates after complete resection and high progression rates after incomplete resection have been observed, although the risk of recurrence or progression is less after complete resection than partial resection. Irradiation of the tumor is protective and the appropriate time point of irradiation after incomplete resection is currently under investigation in a randomized trial. Long-term sequelae substantially reduce the quality of life of ∼50% of long-term survivors, notably extreme obesity owing to hypothalamic involvement. © 2010 Macmillan Publishers Limited. All rights reserved.

Jenke A.C.,Zentrum fur Kinder und Jugendmedizin
Chirurgische Praxis | Year: 2014

Bell palsy is mainly a diagnosis of exclusion, but certain features in history, physical examination and laboratory parameters allow distinguishing it from facial paralysis due to other conditions. The most important differential diagnosis in children is neuroborreliosis. Cerebral imaging is usually not indicated except for patients with persistent paralysis and/or symptoms suggestive for other systemic disorders. In adults apart from physiotherapy and corneal protection corticosteroids given within 10 days of onset have been shown to improve the outcome. In children, there are no clinical studies assessing the benefits of systemic corticosteroids. Therefore, since the rate of spontaneous remission of BELL palsy in children is almost 98% systemic corticosteroids cannot be recommended in pediatric patients.

Muller H.L.,Zentrum fur Kinder und Jugendmedizin
Expert Review of Neurotherapeutics | Year: 2010

Craniopharyngiomas are embryogenic malformations of the sellar region of low histological malignancy, thought to be derived from Rathke's pouch epithelium. With an overall incidence of 0.5-2.0 new cases per million of the population per year, 30-50% of all cases occur in childhood. Overall survival rates are high. However, quality of survival is substantially reduced in many survivors, owing to long-term sequelae, such as extreme obesity caused by hypothalamic tumor involvement, which occurs in up to 40% of all cases. The treatment of craniopharyngioma remains controversial. Radical surgical strategies are associated with poor outcome in craniopharyngioma with hypothalamic involvement. © 2010 Expert Reviews Ltd.

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